Jeanne Morales, 55, with her husband, Jorge Alonso, holds a letter announcing an increase to the health insurance plan that covers her and her husband at their home in Los Angeles. Back-to-back increases have raised the couple's monthly premium from about $1,450 a month to $2,432, a combined increase of 68 percent.

To critics, a 39 percent hike in health insurance for some Californians foretells skyrocketing rates for the rest of us. Not so, says the company, arguing the increase only hits a relatively small number of people, and the economy is to blame.

But the rhetoric from both sides distorts the reality.

It’s true that hikes like the one by WellPoint Inc. apply only to people who buy individual insurance and are unlikely to spread to the majority of Americans covered through their employers. But such hikes also hit a number of Americans who mostly went unmentioned — the 46 million with no insurance at all.

That’s because for most people who don’t get insurance through their jobs and do not qualify for government assistance, the only option is buying individual policies like the ones in WellPoint’s Anthem Blue Cross plan, often with high deductibles.

Raise prices, and people without insurance are even less likely to buy it — healthy people especially. Meanwhile, older and sicker customers pay more and more, running up high health bills in a shrinking pool.

That conundrum is at the heart of a disagreement that has frozen Democratic health reform efforts in Congress. Reform bills would require most of the uninsured to buy coverage, an idea many Americans detest as heavy-handed government.

But without sharing costs across the broadest cross-section of consumers and prohibiting insurers from charging people different premiums depending on their health status, the result is a scenario very much like Anthem’s.

And the sick don’t really have the option of dropping coverage. Pre-existing conditions allow other insurers, who otherwise would provide competition, to decline to cover these individuals.

Jeanne Morales, of Encino, Calif., was outraged when United HealthCare Inc. jacked up the premium of the PacifiCare individual plan covering her and her husband. Back-to-back hikes in October and November raised the couple’s monthly premium from about $1,450 month to $2,432, a combined increase of 68 percent.

Morales wants to drop the policy, but says there’s nowhere else to go. She had a partial hysterectomy to remove a noncancerous ovarian cyst a month ago. She said her insurance broker told her she has to wait at least a year to be symptom free before she can even think about finding another individual insurance product.

Debate heats up at state level

WASHINGTON — Proponents of leaving health care reform to the states have gained momentum as national legislation stalls in Congress, setting off a new debate over who is best able to tackle one of the nation’s thorniest social issues.

Advocates of a state-by-state approach are invoking welfare reform, which originated in the states, and education, an area in which the federal government goads states to improve but lets them choose their own approaches. Imposing national health care reform, they argue, ignores local variations in health care markets and politics.

“Let’s let the states come up with the solutions,” said Missouri state Senate President Charlie Shields, a Republican. “There’s a lot of solutions out there, but the solutions vary state by state.”

— The Washington Post